During a recent 24-hour period at Grady Memorial Hospital, ambulances carried four critically injured patients — three with gunshot wounds, and one from a car crash.
All four patients were bleeding profusely and at risk of dying without immediate help.
But what transpired in those Grady ambulances in the streets of Atlanta is a first-of-its kind for the city: These patients received whole blood transfusions before they arrived at the emergency room, which likely saved their lives, according to Dr. Ryan Fransman, a trauma surgeon at Grady.
Details of the patients’ conditions were not released but Fransman said all four patients had lost too much blood and were at risk of dying before they could reach the hospital. Instead, the patients received immediate transfusions and by the time they arrived at the hospital, they were more stable, according to Fransman.
“A huge game changer,” said Fransman.
Miguel Martinez
Miguel Martinez
Grady joins a small number of hospital and ambulance services around the state and country with the training, equipment and coordination needed to perform the transfusions.
Uncontrolled bleeding is the No. 1 cause of preventable death from trauma. Nationally, it accounts for 35% of deaths from trauma before a patient can reach a hospital, according to the Mayo Clinic.
A person with uncontrolled bleeding can die in as little as five minutes, according to the Mayo Clinic.
“When you get to the hospital, it’s almost like a NASCAR pit crew approach. They’re stopping the bleeding. What we are doing is bringing this outside the hospital to get things started faster. Health care starts when you call 911 and not just when you enter hospital doors,” said Lekshmi Kumar, medical director of EMS at Grady. “What we are trying to do is advance care earlier.”
Most people who suffer a traumatic injury don’t need a blood transfusion before getting to the hospital. Candidates for this procedure are patients losing so much blood they’re showing signs of “hemorrhagic shock,” a medical emergency that includes dangerously low blood pressure and a rapidly increasing heart rate as the body tries to pump more blood to vital organs.
Miguel Martinez/AJC
Miguel Martinez/AJC
Grady is the only remaining Level 1 trauma center in Atlanta, meaning it’s capable of providing care for every aspect of the most complex traumatic injuries and medical emergencies without the need to transfer patients elsewhere.
Kumar estimates the blood transfusions could help as many as 300 of Grady’s trauma patients every year.
Response times for a 911 call asking for an ambulance can vary. Grady declined to share specifics on its ambulance wait times, saying several factors at are play, including distance from Grady, and traffic. But a June 2022 investigation by The Atlanta Journal-Constitution found for the first five months of 2022, Grady’s monthly average response times for life-threatening calls ranged from 10.5 minutes to 13.6 minutes.
Northeast Georgia Medical Center started a pilot program by partnering with EMS services in four counties — Dawson, Habersham, Jackson and White counties — for ambulances to administer emergency blood transfusions for those who might need them during ambulance rides.
“Health care starts when you call 911 and not just when you enter hospital doors. What we are trying to do is advance care earlier."
More may soon follow. Kim Littleton, executive director of the Georgia Medical Association, said other emergency medical providers are also considering administering whole blood transfusions because early results are showing “amazing results.”
Giving patients a blood transfusion before arriving to a hospital marks a major change in care. Historically, EMS teams, including those at Grady, used IV fluids to treat hemorrhaging patients until they get them to the hospital.
Whole blood was the main option for patients needing a transfusion after surgery or major trauma for over 100 years. But there was a major change in the 1960s, when an innovation allowed blood to be separated into its different components: red blood cells, white blood cells, platelets and plasma. This allowed blood banks to serve more patients from each blood donation, and made preserving the blood easier.
But compelling research has emerged showing whole blood works better on trauma victims than IV fluids or components of blood.
A study in the Journal of the American College of Surgeons in 2022 found that whole blood transfusions improved 30-day survival by 60% when compared to transfusions using other blood components in patients experiencing hemorrhagic shock.
The blood transfusion program at Grady comes after several months of research planning and training. Kumar said the whole blood must be kept cool and stored in a special cooler until it’s needed.
The science behind the transfusions gained momentum on the battlefield. Military conflicts in Afghanistan and Iraq, where they often had no choice but to use whole blood therapy, showed the benefits of whole blood transfusions — a discovery that captured the attention in the world of trauma and surgery.
Fransman, who has collaborated with the military to share knowledge and advances in care in combat, said there are many parallels between trauma injuries in combat and the violence unfolding on the streets of Atlanta.
“It’s extremely important for Atlanta to know that injuries we are seeing here at Grady are injuries that are battlefield medicine,” he said. “We’ve seen the assault rifles, we have seen high-powered weapons, we are seeing massive tissue destruction. We are seeing high-speed motor vehicle accidents,” he said. “Yes, we are not seeing (explosions), but the rest of the penetrating stuff, and the bleeding out and the low blood pressure and the shock and instability we are seeing, is similar.”
With the American Red Cross declaring an emergency blood shortage earlier this year, having enough blood could be challenging. Kumar said they have plans in place to ensure zero waste of the blood donations. She and Fransman also made a plea for people to donate blood.
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